Chang Gung Forum: An Exemplary Strategy for Implementing a Multidisciplinary Network of Experts in Craniofacial Anomalies.

INTRODUCTION: The Chang Gung Forum has been dedicated to the care of craniofacial anomalies since 2000. This annual continuing medical education program focuses on orofacial cleft and surgery-first orthognathic surgery by providing up-to-date information and management guidelines. This study explored how the Chang Gung Forum has influenced medical perspectives, decisions, and practices in a multidisciplinary craniofacial team. METHODS: Between 2000 and 2022, 20 Chang Gung Forums have been held. A questionnaire was distributed among 170 attendees who had participated in the forum more than once. The questionnaire collected information on the participants' experiences and levels of satisfaction with the educational program and whether or how it had influenced their clinical practice. RESULTS: Valid responses from 86 attendees (response rate, 50.6%) who had participated more than once were collected and analyzed. The overall satisfaction rate of the Chang Gung Forum based on the respondents' most recent visits was 4.28 ± 0.63 out of 5. Of the respondents, 90.9% acknowledged changes in their clinical practice, with modifications in surgery plans and decisions being the most notable (48.5%). In addition, comprehension increased throughout years of attending the annual forum (P < 0.001). CONCLUSION: The Chang Gung Forum has contributed markedly to the community of congenital craniofacial anomalies. The program will continue providing updated information and influencing the clinical decision-making of health care professionals.

Impact of the Different Types of Le Fort I Maxillary Surgical Movement on Nasal Width Changes: A Photogrammetric Analysis.

BACKGROUND: Le Fort I maxillary movements affect nasal width, but nasal width changes with specific movement types have not been formally addressed to date. OBJECTIVES: The purpose of this study was to analyze and compare the changes in nasal width with different maxillary movements. METHODS: A retrospective study was performed among consecutive patients who underwent bimaxillary orthognathic surgery (n = 138) and who were grouped based on the type of maxillary movement (ie, maxillary advancement with intrusion [MAI], maxillary advancement with extrusion [MAE], and maxillary setback with intrusion [MSI]). Preoperative and 12-month postoperative nasal widths were analyzed photogrammetrically by 2 blinded evaluators. RESULTS: Maxillary advancement with intrusion and MAE presented a significantly (P < 0.05) higher alar base widening than MSI did, with no significant (P > 0.05) differences between MAI and MAE. Maxillary advancement movements (MAI and MAE) showed significantly (P < 0.05) higher alar base widening than maxillary setback movement (MSI). However, no significant (P > 0.05) difference was observed between maxillary intrusion (MAI and MSI) and maxillary extrusion (MAE) movements. CONCLUSIONS: This study shows that the nasal width varies distinctly depending on the type of Le Fort I maxillary surgical movement.

History and Evolution of Orthognathic Surgery at Chang Gung Craniofacial Center: Lessons Learned From 35-Year Experience.

BACKGROUND: Modern orthognathic surgery (OGS) was established on the basis of contributions from multidisciplinary centers worldwide. This study reports the history and evolution of OGS at the Chang Gung Craniofacial Center (CGCC) and identifies the lessons learned from 35 years of experience. METHODS: The total number of OGS procedures managed by the CGCC multidisciplinary team between 1981 and 2016 was determined. The database of the senior author (Y.-R.C.) was reviewed for consecutive OGS procedures performed between 2003 and 2016. A literature review was also performed to retrieve the contributions from the total CGCC team. RESULTS: The 35 years of experience at a single center and 13-year experience of a single surgeon corresponded to 8073 and 2883 OGS procedures, respectively. Moreover, 53 peer-reviewed articles were reviewed. Teamwork (plastic surgeons, orthodontists, and anesthetists) ensured an optimal balance between occlusion functional and facial aesthetic outcomes, with patient safety ensured and a minimum of OGS-related complications. Progression from the conventional orthodontics-first approach to the surgery-first OGS approach decreased the overall treatment time. Transition from 1-jaw to 2-jaw surgery enabled more consistent aesthetic outcomes to be achieved. Conversion from the 2-splint to the single-splint technique enabled development of a more precise tridimensional simulation plan and surgical execution, including in challenging scenarios such as malocclusion associated with facial asymmetry. Clockwise pitch rotation of the maxillomandibular complex has been designed for facial aesthetic purposes in class III malocclusion, whereas counterclockwise pitch rotation of the maxillomandibular complex improves airway function in those with sleep apnea. CONCLUSIONS: The lessons learned from experience and outcome-based articles reveal that OGS has successfully evolved at the CGCC, with a balance being achieved between functional and aesthetic outcomes and effective decreases in the burden of care (ie, morbidity, complications, and treatment time).